Costin Berceanu

Effect of the surface modification of the synthetic meshes used in the surgical treatment of pelvic organ prolapse on the tissue adhesion and clinical functionality

Abstract Stress urinary incontinence and pelvic organ prolapse represent important conditions affecting adult women’s health. Lately, the properties and performance of the polymer materials used in the treatment of pelvic organ prolapse have been improved by modulating from their formula. Materials investigated in our study are polypropylene meshes used by clinicians in surgical treatment of urinary incontinence and utero-vaginal prolapse. In order to make a comparative analysis, we confronted the structure and surface morphology of native synthetic polypropylene meshes with explanted fragments from the same mesh type after clinical use. FTIR investigations revealed little change in structure after implantation, somehow insignificant. Scanning electron microscopy (SEM) demonstrates modification in surface morphology even just by passing through the transobturator passage, whereas after implantation the surface deteriorates. SEM on explanted meshes proves the encapsulation process of the mesh to be more similar to a foreign body reaction rather than to the adhesion and integration of the synthetic mesh into the organism. Histological analysis of the surrounding tissues near explanted mesh was made in some relevant clinical cases, because the tissue response is an important factor in order to evaluate the tissue adhesion at the polypropylene mesh surface. Based on our experiments and clinical experience we’ve designed an adhesion score. It applies to meshes used in pelvic organ prolapse surgery measuring the following important factors: tenacity, extent of adhesion, macroscopic and microscopic aspects and ease of dissection from surrounding tissues.

The Use of Mersilene Tape in Transabdominal Cerclage

Aim: The purpose of this article is to show the use and utility of mersilene tape in medical procedures, such as transabdominal cerclage (TAC). Material and methods: Based on their biomechanical properties, we present our experience with mersilene tape used as treatment for cervical incompetence. Cervical insufficiency or cervical incompetence is defined as asymptomatic cervical shortening and dilatation with the absence of detectable uterine contractions. The mechanical properties of cervical tissue are derived from its extracellular matrix and its most important constituent the fibrillar collagen, alongside other constituents such as proteoglycans, hyaluronic acid, elastin, and water. In the absence of the uterine contractions, the cervix is loaded by intrauterine pressure (including the weight of the growing fetus and amniotic sac), the gravity as well as passive pressure from the uterine wall. These forces also depend on the support action of pelvic floor structures and abdominal wall. The static load resulting from the combination of uterine growth, hydrostatic pressure and gravity seems to be the dominant determinants that cause cervical shortening. The placement of the mersilene tape acts as a barrier between the intrauterine pressure and the cervix. The main advantage of the TAC procedure is the placement of the nonabsorbable suture (mersilene tape at the level of the internal os, avoiding the placement of a vaginal foreign body and subsequently increasing the risk of ascending lower genital tract infection, decreased incidence of slippage, and the ability to leave the stitch in place between pregnancies. Results: The follow-up was without complications regarding the pregnancies treated with transabdominal cerclage. None of the pregnancies terminated prematurely as related to the presence of the tape, but it necessitates to be performed a caesarean section for delivery. Conclusions: Mersilene tape is safe and useful in different medical procedures, including transabdominal cerclage during pregnancy.

Maternal-fetal management and outcome in a case of uterine anatomic abnormality and obstetric antiphospholipid syndrome

The progress of biologic and ultrasound assessments in preg nancy has a favorable impact, demonstrated in the case we are presenting, in terms of monitoring the pregnancy rea ching the term, in a patient diagnosed with obstetrical antiphospholipid syndrome and septated uterus diagnosed after a previous spontaneous abortion at 6 weeks of gestation, when ultrasonographic evaluation and uterine cavity control have been performed. We pay attention to this case from the point of view of placental abnormalities that can occur if the uterine malformation leads to an anatomical perturbation of the insertion and development of the placenta, but also to the placental abnormalities from the antiphospholipid syndrome in which thrombosis can lead to placental dys function. These aspects are supported by laboratory tests that high light the antiphospholipid antibodies and ultrasound findings obtained from pregnancy monitoring (placental anomalies, fetal growth curve, uterine artery, umbilical artery and middle cerebral artery Doppler flows, amniotic fluid index). From the category of anti-phospholipid antibodies, anti-annexin V antibodies are directly involved in the disruption of placenta as early as 7 weeks of gestation.

Colposcopic assessment and outcome in low grade cervical intraepithelial neoplasia treated with loop electrosurgical excision procedure

The aim of the research was to assess the outcome of persistent (≥two years) low-grade cervical intraepithelial neoplasia (CIN 1) medicated with loop electrosurgical excision procedure (LEEP). An analysis of 38 topics with persistent biopsy-confirmed CIN 1 diagnosed after low-grade squamous intraepithelial lesion (LSIL) or atypical squamous cells of undetermined significance (ASC-US) on Pap test and treated using LEEP was performed. Post-LEEP follow-up were scheduled in 6 months, 1 year, and yearly thereafter: cytology, colposcopy, and plasma diagnostic examinations. There were 38 LSIL patients treated with LEEP conization. About 6 patients were excluded from the study due to subsequent hysterectomy and 2 patients never attended the follow-up schedule in the rest. The remaining 30 patients were retrospective studied for the incidence of recurrent rate. The mean age of the patient was 44 years. About 50% of patients were multiparity and nearly one - third used oral contraceptive pill. The results of this study suggest that the incidence of CIN 2+ lesions during follow-up of persistent biopsy-confirmed CIN 1 after ASC-US/LSIL treated by LEEP is very low.

The Doppler profile of ovarian endometrioma

Aims. To characterize the vascularity of endometriotic cysts using color Doppler ultrasound and to differentiate more accurately between endometriotic cysts and other pelvic cyst masses. Methods. Two prospective studies were initiated: the first included 50 patients diagnosed with ovarian endometriotic cysts and 50 patients without gynecological pathology, in whom the resistance index (RI) of the uterine artery, ovarian artery and endometrial arcuate arteries in the early secretory phase was determined by endovaginal Doppler ultrasound; the second study included 50 patients diagnosed with ovarian endometriotic cysts, in whom the RI of the uterine artery, ovarian artery and cyst wall arteries in the late proliferative phase and in the late secretory phase was determined. Results. In the early secretory phase, the vascular flow through the uterine artery was significantly higher in patients with ovarian endometrioma. These patients had increased endometrial vascularity in the early secretory phase compared to the control group. In the late secretory phase, the vascular flow through the ovarian artery was higher compared to the late proliferative phase in patients with ovarian endometrioma. The vascularization of the ovarian endometrioma wall was significantly increased in the late secretory phase compared to the late proliferative phase. Conclusions. Vascularization, described through the arrangement of vessels, vascular density and vascular resistance, is an important factor in the evaluation of ovarian endometrioma.

Intraperitoneal Fat through GRP78: A Risk Factor for Endometrial Cancer.

Introduction. The identification of biological markers that indicate an increased risk for the development or recurrence of endometrial cancer (EC) in obese women might be useful for decreasing EC mortality and morbidity. Glucose-regulated protein 78 (GRP78) is a major protein of the endoplasmic reticulum expressed in all normal cells. Overexpression of GRP78 has been reported to be a tumoral biomarker. Increased detection of GRP78 is positively correlated with the tumoral stage and prognosis. This study aimed to identify a correlation between intraperitoneal fat, plasma GRP78 levels, and EC. Materials and Methods. Two groups of patients were included in the study: group I, 44 patients diagnosed with EC, and group II, 44 patients without gynecological pathology or inflammatory disorders. Visceral fat was determined by ultrasound and plasma GRP78 levels were measured. Results. Plasma GRP78 levels were significantly higher in patients with EC compared to the control group. Intraperitoneal fat was in a positive linear correlation with the plasma GRP78 level (p < 0.0001). Conclusion. The measurement of the GRP78 level associated with the determination of intraperitoneal fat can be a useful predictor for EC.

The role of adipose tissue as endocrine organ in the metabolic programming of fetuses derived from obese mothers

We aim to present the endocrine and paracrine role of the cytokines secreted by hypertrophied maternal fat cells on fetal and later on neonatal metabolic profile. The study used an animal model in order to analyze the influence of maternal adipokines secretion of fetal metabolism. We selected 50 female Wistar rats weighing between 200-250 g (normal weight 100-150g) to whom we induced obesity by high-fat, high-calorie food intake (80% of diet saturated fatty acids) and tracked the correlation of maternal adipokines secretion with placental and fetal lipid peroxidation level. The low adiponectin and increased leptin values as adipokines secreted by adipocytes of obese mothers were correlated with the level of placental and fetal tissue lipid peroxidation (from the liver, pancreas, brain), measured by elevated malonyldialdehyde and total thiols and the decreased levels of glutathione. It has been known for decades that fat tissue is not inert, but a true endocrine organ, which responds by secreting adipokines to different energy and hormonal stimuli. Endocrine secretion of adipokines from the adipocytes of obese mothers is positively correlated with placental and fetal lipid peroxidation levels. Fetal metabolic programming as an inducible phenomenon is explained partly by the influence of excess secretion of maternal adipokines.